As an experienced hospice nurse, I understand the challenges faced by terminally ill patients and their families when dealing with hallucinations, especially in conditions like Lewy Body Dementia, Parkinson’s disease, and other neurodegenerative diseases. Hallucinations can be distressing and confusing for patients and their loved ones. Still, with the right approach and a combination of pharmacological and non-pharmacological methods, we can help manage these symptoms to improve comfort and quality of life.
Understanding Hallucinations
Sometimes, people may see, hear, or feel things that are not there. These are called hallucinations. Hallucinations can happen to anyone, but they are more common in people who have certain health problems, such as Lewy Body Dementia or Parkinson’s disease. These health problems can affect the brain’s work and make it harder to tell what is real and what is not.
Hallucinations can be scary or confusing for those with them and those around them. They can also make it harder to do everyday tasks, such as driving, working, or caring for oneself. That is why it is essential to understand what causes hallucinations and how to cope with them.
Best Practices for Managing Hallucinations
Hallucinations can be hard to deal with, but there are ways to help yourself or someone else. There are two main types of methods: medicine and other strategies. Medicine can help reduce the frequency and intensity of hallucinations by affecting the brain chemicals involved in the disease process. However, the medicine may not work for everyone or have side effects. Therefore, we must try both non-pharmacological methods and medications as appropriate.
Non-Pharmacological Interventions
Non-pharmacological methods are ways to help yourself or someone else who hallucinates without using medicine. These methods can make the person feel more comfortable and less upset by the hallucinations. They can also help the person stay in touch with reality and focus on other things. Some of the non-pharmacological methods are:
Reality Orientation: This means helping the person remember where they are and what is happening. You can gently tell them the date, time, and place. You can also show them things that are familiar to them, such as photos, calendars, or clocks. This can help the person feel more grounded and less confused.
Distraction and Redirection: Helping someone pay attention to something else when hallucinating. You can ask them to do something they like or are good at, such as playing a game, doing a puzzle, or making a craft. You can also talk to them about something that interests them, such as their family, friends, or hobbies. This can help the person forget about hallucination and enjoy themselves.
Validation and Empathy: This means listening to the person and understanding their feelings. You can say things like, “I can see that you are scared,” or “I know this is hard for you.” You can also ask them to tell you more about what they see, hear, or feel. You can say things like “What does it look like?” or “What does it say to you?”. This can help the person feel you care and are not judging them.
Optimizing the Environment: This means making the place where the person lives or stays more comfortable and familiar. You can reduce the noise by turning off the TV or radio or closing the windows. You can also ensure enough light, such as turning on the lamps or opening the curtains. You can also put things the person likes or recognizes, such as pictures, flowers, or stuffed animals. This can help the person feel more relaxed and safer.
Reassurance from Caregivers: This means having someone kind and supportive to help the person. This can be a family member, a friend, or a professional. The caregiver can stay with the person, hold their hand, or hug them. The caregiver can also say things like “You are not alone” or “I am here to help you.” This can help the person feel more calm and secure.
Pharmacological Interventions
Sometimes, non-pharmacological methods may not be enough to help yourself or someone else who hallucinates. In that case, you may need to use medicine to reduce the hallucinations or make them less bothersome. However, medicine is not always the best option, especially in hospice care, where we want to make the person as comfortable and safe as possible. That is why you should always talk to your doctor before using any medicine and follow their instructions carefully.
Two main types of medicine may help with hallucinations:
Antipsychotic Medications: These medicines can affect the brain chemicals involved in the disease process. They can help lower the frequency and intensity of hallucinations. However, they can also have side effects like drowsiness, confusion, or movement problems. They can also interact with other medicines that the person may be taking. That is why they should be used in low doses and only when necessary.
Anxiolytics: These are medicines that can help reduce anxiety and agitation that hallucinations may cause. They can help the person feel calmer and more relaxed. However, they can also have side effects, such as drowsiness, dependence, or withdrawal symptoms. They can also interact with other medicines that the person may be taking. That is why they should be used sparingly and only when needed.
If your loved one has Lewy Body Dementia or Parkinson’s Disease, you should ask the doctor to confirm with a pharmacist before using any medicine. These diseases can make a person more sensitive to the effects of drugs and may cause more problems. The doctor and the pharmacist can help you find the best medicine and dose for your loved one.
Conclusion
Managing hallucinations in hospice care requires a compassionate and personalized approach. As hospice nurses, we strive to provide comfort, empathy, and support to patients and their families during this challenging time. By combining non-pharmacological techniques with the judicious use of medications, we can create a care plan that respects each patient’s unique needs and helps them find peace and comfort in their final journey.
